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Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator - 0 0 <br /> APPLICATION FOR LAND USE PERMITS 3. <br /> N o `xJ <br /> �r <br /> �y1 /1 C <br /> OWNER �/42OL-D rr/. � t♦771 A/$O.✓ TELEPHONE <br /> d <br /> m <br /> DDRESS 0 <br /> MAILING A <br /> �9/y� G©.uG < fJ-/r� �a�p �A-�✓3u�y /,r/, S�B3d .. <br /> n + r m <br /> PROPERTYADDRESS DOo <br /> se f-l'v vs' reo✓•✓ Flo X />•a6L /y w I <br /> LEGAL DESCRIPTION(see tax receipt) PG L (yo U L o T 6 9-,L/SGccj <br /> I ,3y�w/(flo2� • 1 <br /> DWELLING/BUILDING 1:1GARAGE/ACCESSORY STRUCTURE I'!_`l—ADDITION ❑ ^ <br /> N o <br /> TYPE OF PERMIT(S): cQ <br /> FILLING/GRADING ❑ ElCAMPING UNIT ❑ SUBDIVISION n <br /> STRUCTUREIADDITION USE: 6'+e'N/ �L <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) <br /> BUILDING CONTRACTOR: CLEIt'RH '60/1D/'V6 CO.Pd, <br /> '2 <br /> m a <br /> A PLOT PLAN MUST BE PROVIDED ON AT LEAST AN 81/X 11 SHEET OF PAPER. ANY INCOMPLETE OR 3 <br /> ILLEGIBLE PLOT PLANS WILL BE RETURNED. n <br /> O <br /> M H <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (AERIAL OR TOP VIEW) O m <br /> T n <br /> n Z <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. 0 aOi � <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS(EB)AND ALL NEW BUILDINGS(NB)AND INDICATE m <br /> NORTH(N). C ra <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A)BUILDING(S)TO ALL LOT LINES,(B)BUILDING(S)TO m Ta <br /> CENTERLINE OF ROAD,(C)BUILDING(S)MEASUREMENT TO THE ORDINARY HIGH WATER MARK(OHWM)OF I Z <br /> LAKE,STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. o <br /> 4. SHOW THE LOCATION OF THE WELL(W),SEPTIC TANK(ST)AND DRAINFIELD(DF),AND ALL DISTANCES TO <br /> BUILDINGS, ROADS, LAKE, LOT LINES. I <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. N <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER,BUILDER,CONTRACTOR, ETC.,THE PLANS 0 <br /> MUST BE SIGNED AND DATED BY THE OWNER. ,o <br /> O � <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MAYBE DONE WHEN a g <br /> NEEDED. cy' CA PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW. Z o Vl � <br /> CONDITIONS OF PERMIT: ((�� O <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT y' <br /> ISSUANCE. I _ <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. (� <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY (� <br /> PERMITTED. <br /> 4. NO STRUCTURES, INCLUDING RETAINING WALLS, ETC., ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. <br /> 6. (a c y a n M n F m <br /> om CN ." oS. i <br /> 7. Z c ,nmo o � <br /> O N 2 z <br /> I declare that this application (including an accompanyingschedule has been examined b me and to the best of m _ I O <br /> PP ( 9 Y ) Y Y E � 2 � � ; C <br /> knowledge and belief it is true, correct and complete. I acknowledge that 1 am responsible for the detail and accuracy of [ d n ; <br /> all Information contained in this application(including any accompanying schedule)and I further declare that I recognize m $ m <br /> that this information I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to is- O <br /> sue a permit. I further accept all liability which may be a result of the County of Burnett relying on this information I am G[ 0 : <br /> providing In this application. I agree to permit county officials charged with administering county ordinances or other <br /> authorized person to have access to the above described premises at any reasonable time for the purpose of inspection. <br /> m n : <br /> SIGN HERE r Lru.— L /.2 p'td1J06 m n <br /> v, n <br /> ( ign ore o owner b ding contractor) (date) 0 <br /> ZONING ADMINISTRATOR <br /> Q O N N W(J N O <br /> TOWNSHIP PERMITS MAY BE REQUIRED d o u o v u v o <br /> THIS P RMIT SHALL EXPIRE ONE Y R F O D E OF I SUAN E <br /> ei'mt�4-4- IQ-�/ mcl -f f-�rvl ���n <br />